Recovery Messages & News

What is Sobriety?

By Dr. Raju Hajela


People often associate the term ‘sobriety’ or ‘being sober’ as the opposite of being intoxicated, hence, thinking that sobriety is achieved once one has established abstinence from the substance that may have been resulting in problems in one’s life.  Reality is, though, that the problems in the brain go much further than no longer being intoxicated acutely, which cannot be addressed by just not using or acting out.  The way to address those problems is recovery, which requires addressing the biological, psychological, social and spiritual domains in order for the body, mind, and spirit to result in a healthier functioning position, which can be called sobriety!

Recognition of these basic ideas led the American Society of Addiction Medicine (ASAM) to establish definitions for Abstinence, Recovery and Sobriety as follows:

Intentional and consistent restraint from the pathological pursuit of reward and/or relief that involves the use of substances and other behaviors.
These behaviors may involve, but are not necessarily limited to, gambling, video gaming, spending, compulsive eating, compulsive exercise, or compulsive sexual behaviors.

A process of sustained action that addresses the biological, psychological, social and spiritual disturbances inherent in addiction. Recovery aims to
improve the quality of life by seeking balance and healing in all aspects of health and wellness, while addressing an individual’s consistent pursuit of
abstinence, impairment in behavioral control, dealing with cravings, recognizing problems in one’s behaviors and interpersonal relationships, and dealing more effectively with emotional responses.

An individual’s recovery actions lead to reversal of negative, self-defeating internal processes and behaviors, allowing healing of relationships with
self and others. The concepts of acceptance and surrender are also useful in this process. Since some prescribed and non-prescribed medications can interfere with recovery, it would be prudent to consult with an Addiction Specialist Physician in selected cases.

A state of sustained abstinence with a clear commitment to and active seeking of balance in the biological, psychological, social and spiritual
aspects of an individual’s health and wellness that were previously compromised by active addiction.

It is important to appreciate that abstinence and recovery are both defined and described as a process that is more consistent with progress rather than a state to achieve (perfection).  As much as sobriety is defined as a state, it is a dynamic state achieved by addressing abstinence and recovery, as both are necessary components.

It is important to appreciate that sobriety is neither abstinence alone nor recovery alone.

ASAM has also defined relapse as follows:

A process in which an individual who has established abstinence or sobriety experiences recurrence of signs and symptoms of active addiction, often including resumption of the pathological pursuit of reward
and/or relief through the use of substances and other behaviors. When in relapse, there is often disengagement from recovery activities. Relapse can be triggered by exposure to rewarding substances and
behaviors, by exposure to environmental cues to use, and by exposure to emotional stressors that trigger heightened activity in brain stress circuits. The event of using or acting out is the latter part of the process, which can be prevented by early intervention.

Relapse is also defined as a process where signs and symptoms of active addiction can occur along biological, psychological, social and spiritual dimensions.  Generally, biological symptoms (such as anxiety, panic, depression, using substances or
behavioural acting out) are preceded by social symptoms (association with risky people, places and things), which are preceded by psychological symptoms (such as addictive thinking and a dysfunctional emotional response), which are preceded by spiritual symptoms (such as lack of meaning, purpose and direction in life).  Seeking relief from biological symptoms drives active addiction overtly, whereas recovery action requires spiritual grounding; becoming aware of and dealing with addictive thinking and the dysfunctional emotional response; and boundaries with risky people, places and things.

By definition, the three circuits driving relapse are –
exposure (biological), environmental cues (social) and stress (psychological). It is important to recognize that relapse can happen in recovery.  Although relapse is
not a desirable thing necessarily, if it happens it does not mean that recovery is lost.  It just means more action is needed to maintain abstinence, recovery and keep working towards enhancing sobriety!